COVID-19 threatens uptake of contraceptives among women and girls

As the COVID-19 pandemic accelerates, fears are increasing about the effect of the pandemic on women and girls' sexual and reproductive health and their access to care.

This is threatening to erode national efforts to shrink young women and girl’s already low level of contraceptive uptake leading to an increase in teenage pregnancy, in some deprived communities.

For many of these young people, falling back on their old method and knowledge of preventing pregnancies by practising all kinds of myths such as urinating immediately after having unprotected sex, has landed them in trouble, as they now have to cope with either an unplanned pregnancy, or face a Sexually Transmitted Infection (STIs).

Unimpeded access to modern contraceptives, especially for adolescence in deprived and rural communities remains a big challenge under COVID-19, where strict lockdown measures are deployed by the government to curtail the spread of the virus, creating a vacuum for the supply of contraceptives.

Abigail, a 15 year old girl at Chorkor, a densely populated fishing community in Accra, in an interview with the Ghana News Agency, did not deny that she is sexually active, but said she uses the injectable contraceptive for protection. Unfortunately, Abigail could not go for her short at the stipulated date due to the COVID-19 lockdown, leading to a pregnancy she did not intend to keep.

Asked why she did not insist on a condom use? She said, “My boyfriend does not like the condom and will not have patience with me when I tell him I am not ready. He will get angry with me and abandon me for some time, but since he takes good care of me, I cannot deny him of sex”.

Abigail now blames her misfortune on the closure of the Support Centre at the Ussher Fort Polyclinic at the time, saying, “If I had gone for my injection, I would have been protected and no pregnancy will have occurred,” and said her parents are so disappointed in her.

Okailey (not her real name) a Senior High School (SHS) form two student, is also at home while school is in session because she is pregnant and have been unwell preventing her from joining her colleagues in class.

She confirms that some of her friends like her, are also pregnant while others are already mothers in their teens because they all became complacent and adamant about the pieces of advice from their parents and elders in their community to change their lifestyles.

She said; “My friends and I like to go out in the evening to have fun, but these days we are not able to do that because of the COVID-19, so we just meet with our boyfriends to chat and sometimes it leads to sex,” but indicated that she always firmly insists with her boyfriend to wear a condom before sex but he will refuse and for fear of losing him, she has given up the fight.

These interviews, under the “Mobilizing the Media for Fighting covid-19" project being implemented by the Journalists for Human Rights in collaboration with the Ghana Journalists Association (GJA)”, strongly suggest that although there is an increase in knowledge and acceptance for contraception among these group of adolescent girls, poor reach and negative attitudes pose a barrier that must be urgently addressed to prevent unintended pregnancies and unsafe abortion.

Studies show that the adolescent pregnancy situation in Ghana suggests that much progress have been made in terms of achieving a steady fertility decline, improvement in health outcomes and there has been improved infant health and education, however, there is still a wider gap between male and females.

The contribution of adolescents and young people to fertility is of huge importance because early, unplanned, unwanted pregnancies, and multiple sexual partnerships expose many young people to SRH risks including HIV and AIDS.

The 2010 Population and Housing Census, reveals that Ghana’s population has remained largely youthful with 22.4 per cent of the population represented by adolescents of age 10 to 19 years, and indicates that about 62 per cent of the country’s population in 2010 was less than 25 years.

It says the country’s demographic transition signals the onset of a demographic dividend, which requires deliberate efforts and strategies to harness its benefits, therefore, adolescent pregnancy continues to undermine the quest for women empowerment through higher education and career development.

This undermines the United Nations Sustainable Development Goal 3 (SDGs), on “Good Health and Well Being,” as well as the Goal 5 regarding “Achieving Gender Equality and Empowerment of all Women and Girls” and constitute a violation of their rights to equality.

Data from the 2017-2018 Multiple Indicator Cluster Survey (MICS) found contraceptive method use among all, to be mixed showing a 3.8 per cent of condom use, 24.3 per cent for the pill, injection 34.4 and the implant was 21.6 per cent ages.

However, data from the FP2020’s (Family Planning) Annual Report: “The Arc of Progress 2019-2020”, shows that an estimated 1,790,000 women in the year 2020, were using a modern method of contraception in Ghana, and this has prevented 681,000 unintended pregnancies, with 243,000 and 1,300 unsafe abortions and maternal deaths respectively averted.

The FP2020 Core Indicators Fact Sheet also compares additional users of modern contraceptives which increased from zero per cent in 2012 to 719,000 in 2020, whereas modern contraceptive prevalence among women also went up from 16.5 to 23.2 per cent within the same period.

However, it says the unmet need for modern contraception falls low at 31.9 per cent in 2020 compared to 36.9 per cent in 2012, even though stringent efforts are being made to satisfy the high demand which in 2020 was 48.3 per cent compared to 36.5 per cent in 2012.

Although Ghana continues to increase the number of its modern contraceptive users with improved provider training, expanded method mix, and demand creation for FP to improve the health women and girls, experts have expressed fears that the current crisis can erode the gains made over the years.

It can also aggravate lack of women’s participation in quality health care and contraceptive usage, which violates their rights under Article 25 (2) of the United Nations Convention on Human Rights, which requires that special care and assistance be given to motherhood and childcare, hence, any distortions in programmes and activities constitute a violation to this provision.

Article 25 (1) of the same also enjoins everyone to have access to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

Hence, a violation of these rights is seen as a failure by the government to sustain the healthy environment needed for young people, especially young women to thrive, because unintended pregnancies and unsafe abortions could be devastating leading to a cycle of poverty, sicknesses, food insecurity, poor shelter, unemployment affecting national development as a whole.

Mr Niyi Ojuolape, the Country Representative of the UNFPA Ghana, is passionate about the fact that universal access to Sexual and Reproductive Health by 2030 corresponds to Goals 3.7 and 5.6 of the United Nations Sustainable Development Goals (SDGs).

The Ministry of Gender, Children and Social Protection have also developed a Five-Year Strategic Plan, to address adolescent pregnancy in Ghana between 2017 and 2022.

The Plan, which is an operational document prepared by the Gender Ministry, Ministry of Health and other relevant stakeholders seeks to provide appropriate, coherent and cost-effective measures that have national ownership to achieve the goal of addressing the high rate of teenage pregnancy in Ghana.

This Plan further provides a clear vision, and direction for all stakeholders involved in the sexual and reproductive health sector in Ghana, and sets out the national goal, strategic objectives and interventions and a monitoring plan to aid the full integration of adolescents issues into the development process, to harness their potential to attain the overall sustainable development in the country.

It serves as a complement to the various policy and programmatic interventions currently ongoing to position adolescent sexual and reproductive health as a broad development issue within the context of the demographic dividend and the long-term development planning agenda.

Dr Leticia Appiah, Executive Director of the National Population Council suggests, that giving priority to the sexual and reproductive educational needs of young people is very crucial to their holistic development as they can understand the dangers or differences that their choices and decisions can bring about.

She said although the policy environment in the country is favourable for the promotion of the health and development of adolescents and young people, issues on adolescent health must be properly integrated to improve access to information on health and health services relevant to the gender-specific needs of adolescents and young people to enable them to make informed decisions.

There is a high level of misconception and misinformation about sex, fertility and contraception in Ghana, and young people often lack knowledge of the rights and services available to them, they also lack the knowledge and skills to live life enhancing lifestyles for promotion of health, while a significant number of parents also lack the knowledge and confidence to talk to their children about sex and relationships.

There is, therefore, the need to intensify efforts through Social and Behavioural Change Communication strategies including comprehensive school-based sexuality education and mass media messaging, to change the underlying norms and attitudes that perpetuate poor health outcomes for young people.

On comprehensive sexuality education, programmes should focus on providing accurate information about human sexuality, giving an opportunity for young people to develop and understand their values, attitudes, and beliefs about sexuality, to help them to develop relationships and interpersonal skills, while exercising responsibility regarding sexual relationships, including addressing abstinence, pressures to become prematurely involved in sexual intercourse, and the use of contraception and other sexual health measures among other things.